Concordia Star Medical LLC
Clinic/Center, Primary Care in Puyallup, WA. Organization (NPI-2).
NPI number1508134792
StatusActive
Last updated in NPPESMay 15, 2015
Details
- NPI
- 1508134792
- Entity type
- Organization (NPI-2)
- Legal business name
- Concordia Star Medical LLC
- Organization subpart
- No
- Enumeration date
- Dec 2, 2011
- Last updated
- May 15, 2015
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 261QP2300X | Clinic/Center, Primary Care | MD00034362 | WA | Yes |
| 261QM1300X | Clinic/Center, Multi-Specialty | MD00034362 | WA | |
| 261QU0200X | Clinic/Center, Urgent Care | MD00034362 | WA |
Practice location
118 7th Ave SwSuite A
Puyallup, WA 98371-6803
Phone 253-579-0067 · Fax 253-579-0068
Mailing address
118 7th Ave SwSuite A
Puyallup, WA 98371-6803
Phone 253-579-0067 · Fax 253-579-0068
Authorized official
Ladie Christine Arana-Domondon
Owner - Ceo
2532099009
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All 7 Primary Care Clinic/Center providers in Puyallup · All 4,232 providers in Puyallup
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